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The NIOSH Hazardous Drug List
• Providing a comprehensive risk management plan that entails assessing exposure risks, implementing control measures, and conducting periodic exposure assessments. • Improving staff communication regarding haz- ardous drugs and promoting a culture of safety and accountability.
MANAGING HAZARDOUS DRUG EXPOSURES: INFORMATION FOR HEALTHCARE SETTINGS
The potential exposure of workers from handling a hazardous drug depends on several factors unique to each work setting. Such factors include: • the dosage form of the drug, • the routes of exposure, • the frequency, duration, and magnitude of exposure, • work practices, and • the presence or lack of any exposure controls such as personal protective equipment. engi- neering controls, or administrative controls.
RISKS FROM EXPOSURE TO HAZARDOUS DRUGS
USP CHAPTER <800> NIOSH defined the criteria of hazardous drugs and established a list of hazardous drugs in the United States. The US Pharmacopeia (USP) developed standards for handling these hazardous drugs to minimize the risk to public health in USP <800>. The goals of these standards are to help increase awareness, provide uniform guidance to reduce • Increased cancer risk to include leukemia. • Organ damage such as the liver and kidneys. • Genetic damage to include genetic mutations and chromosomal abnormalities. Adverse reproductive events include infertility, spon- taneous abortions, and congenital malformations. Although the exposures healthcare workers may receive are normally lower than the therapeutic doses administered to patients undergoing medi- cal treatment, however any pharmacologic effect happening because of occupational exposure is considered unwelcome even if it can be debated that the effect is beneficial. Exposure to hazardous drugs can cause a range of adverse health effects. These effects can be classified as acute, chronic, and adverse reproductive effects. Acute effects include: • Skin and mucous membrane irritations • Nausea, vomiting, and diarrhea. • Alopecia (hair loss) • Other acute symptoms such as lightheadedness, dizziness, nausea, headache, allergic reactions, sore throat, and cough. Chronic effects include:
DEVELOPING A FACILITY SPECIFIC HAZARDOUS DRUG LIST
Hazardous drug evaluation must be a contin- uous process completed on a routine basis within a facility. The employer can develop a facility-specific list of hazardous drugs by com- paring the drugs in their workplace to those on the NIOSH List of Hazardous Drugs. In addition, the employer should assess the haz- ards associated drugs as they are added to the workplace’s formulary or as new information on the potential hazards of drugs become available. At that time, a reassessment should be made to determine whether the medication should be included on the facility-specific list. There are many benefits of developing a facility-specific hazardous drug list. These include • Identifying and managing medications that may present hazards to healthcare workers. • Minimizing staff exposure and potential for adverse health effects. • Providing better staff training, safer work prac- tices and ensuring appropriate engineering and administrative controls are in place. • Adhering to Occupational Safety and Health Administration (OSHA) and US Pharmacopeia (USP) standards for handling hazardous drugs. .
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